TRT & Thyroid Optimization - Different Doctors?

Pharma TRT
1

Do people use different doctors for TRT & Thyroid optimization? Or is there cross over where the same doctor that specialized in TRT handles thyroid? I am going through defy medical for both.

I JUST started (less than a week ago) TRT with them. Previously, we were addressing my low testosterone (and low estrogen) with conservative approaches, and later began addressing the thyroid. The thyroid improved, then seemed to then then seemed to go bad again after switching up my thyroid protocol. They have since changed my thyroid protocol to something that doesn’t seem to make sense to me, or other people I’ve mentioned it to.

I’m wondering if Defy Medical maybe specializes in HRT, but isn’t best suited for thyroid? Or is there a consensus here that they are well suited for both?

Showing just my thyroid labs here for simplicity:

After 3 months of 1.5 grains armour thyroid & 20mcg cytomel:

Labs from 8/6/19
Reverse T3 15.6 (9.2 - 24.1)
Free T3 - 3.9 (2.2-4.4)
Free T4 - 1.05 (0.82 - 1.77)
TSH .006 (.450 - 4.500)

After 3 months of taking 45mcg cytomel:

Labs taken 11/12/19
Free T3 - 2.4 (2.2-4.4)
Reverse T3 6.7 (9.2 - 24.1)

After labs from 11/12/19, the doctor now has me on one dose of 20mcg Cytomel in the morning. The reasoning was to wean off thyroid medication now that the reverse t3 is down. She also thinks that my symptom of insomnia may be caused by the cytomel, which this should fix. I’m not so sure cytomel is the contributor.

My thoughts would be since now my Free T3 is not optimal, like it was in August, that the protocol would not be to DECREASE Cytomel. I’v enow started taking Testosterone Cyp & HCG, so I’m assuming this should help with some symptoms of weight control, energy, and sleep. However, I’m wondering if the thyroid is not being addressed the way it should? The plan is to continue this protocol for 3 months, and have everything rechecked. I guess I should mention that I have very high SHBG (91), but that was not given as part of the doctor’s reasoning for adjusting the thyroid med like she did.

Is the thyroid being addressed the way it should? Should I seek an alternative doctor when it comes to thyroid? With TRT presumably improving some symptoms, what symptoms should I be on the lookout for to indicate the thyroid is not optimal, and in need for adjusting?

Thank you for insight and feedback.

2

Dr. Saya used to be a sick care endocrinologist, he wasn’t happy with the sick car system not allowing him to treat his patients do to the low standard for treatment. He doesn’t go by the same standards as sick care as far as hematocrit is concerned, he will hold your TRT script hostage is hematocrit gets 52%>, he also majored in cardiology and believes thinker blood means more pressure in the pipes is good long term.

Defy is into anti-aging, they specialize in thyroid, peptide and even growth hormone injections, a one stop shop for anti-aging.

3

You should probably proof read this part.

4

Not so fast, you forgot one.

1 Like
5

I couldn’t handle reading that far

6

@Stealthforce
Did you tell them you want to go back to the protocol that worked? Seems to me that you complained about insomnia so they adjusted to not lose you as a client (not in a malicious way necessarily). They have to go based on what you tell them in addition to blood work. Tell them what you want

7

Do you happen to have your thyroid levels before treatment?

Going with T3 only is not recommended according to current medical knowledge.

Despite a lot of controversy on that topic evidence based medicine still recommends to treat with T4 first until TSH is around 1 and only if symptoms still persist - that’s about 15% of patients - treat with a T4/T3 combo.

8

No. Makes zero sense.

Unless I felt great, not sure I’d be happy with 2.4 fT3 even if rT3 was zero.

Out of curiosity, why did they give you hCG?

9

Before any treatment, my thyroid was:

TSH - 2.090 (.450 - 4.5)
Free T3 - 2.4 (2.0-4.4),
Reverse T3 (13.8 (9.2 - 24.1)
Free T4 - 1.23 (.82-1.77)

I will say that I’m being treated by Defy Medical, but not by Dr. Saya himself. I’m happy Defy has addressed my issues where a local endocrinologist did not. I’m told all Defy Doctors are all following Dr. Saya’s protocol. However, I will say that I’ve had multiple consults with different Defy doctors, and there are times where one has questioned the previous doctor’s prescription. This align with the lab work is why I try to get other opinions.

The doctor I did my consult with,w hen asked about the thyroid prescription, said:

“it does not look like you need the armour based off your labs, increasing your T3 can improve your energy, but your antibodies were negative indicating you are not dealing with an autoimmune issue. Your reverse T3 was elevated at one time which can also cause many of the symptoms you were experiencing, however that is lower now. Many people are able to wean off of the Cytomel when their RT3 drops. I think you could be waking up throughout the night because of the Cytomel so lowering that may also help you sleep better, increase your testosterone and your energy. Also, armour and Cytomel can increase your SHBG and we are trying to lower that to free up some testosterone for you. I think its worth giving a shot to see how you respond, if we need to go back to armour or Cytomel in the future I’m not opposed but give it a little time. Sometimes it takes time to get everything completely balanced.”

.

I will say that both my energy and sleep has been pretty consistent when not on thyroid, and when on thyroid. The one big thing that changed was my weight would not stop increasing before medication, then after several trials of different thyroid doing, we eventually dialed in what seemed like the correct dosing, which led to solid weight loss, and the 3.9 Free t3 numbers from the 8/6/19 labs mentioned above. The protocol was then modified to drop the reverse t3, and numbers now do not look as favorable.

I also will share my energy was zapped last couples of weeks, even when taking 45mcg of Cytomel. That kind of came out of nowhere, but perhaps that’s more to speak with the low testosterone and estrogen?

Given my the one big symptom is weight problems when my thyroid dosing wasn’t correct, and weight fluctuations will be a gradual thing rather than a day by day monitoring thing - what symptoms should I be monitoring to know if my thyroid protocol definitely needs to be switched up? Two things I’ve felt recently is lack of energy (which I’m assuming will get better with TRT) and increased hunger (unsure if it’s at all related to thyroid)

To answer about why they gave me HCG - remaining fertile is important to me. But the doctor did say they often prescribe HCG to counter pain that some people experience in the testes when on TRT?

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There’s only one way to find out and that would mean labs are needed, but it might mean thyroid meds need as increase, but you’re in good hands.

11

No, not unless you are taking your Cytomel at night. T3 has a short half-life, which is why T3/T4 or T4 only preparations are standard.

12

I honestly didn’t feel a difference in my sleep when I was taking Cytomel at night vs. when I was taking it Morning & Afternoon. Now that I cut the afternoon dose and am sticking to only the 20mcg morning dose, my sleep is still the same. I began taking CBD OR melatonin to keep me asleep through the night a couple months ago.

How long should I give this (monitoring my weight and sleep) before contact the doctor again about putting the t4/t3 combo back in? A couple things I will also share is that at one point they had me on 2 grains Armour only, and I had no relief of symptoms. It wasn’t until the 1.5 grain Armour + 20mcg Cytomel that I felt better. BUT in 3 months, my SHBG shot up from 74 to 117.

I know there is optimal T3 levels, but I’ve never heard the optimal reverse t3 levels. Is there one?

Also, outside of the thyroid - now being on TRT with my SHBG currently at 91, by injecting testosterone, my body will still produce Free T, despite the high SHBG? What about my e2 levels? WIth low E2 and high SHBG, will TRT still help lift that e2 back up?

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I don’t see how anyone could have healthy FT with an SHBG at 91, in this case more androgens are needed to suppress SHBG in order to get an increase in FT. When FT increases, estrogen should also increase as well.

14

They currently have me on Boron and Zma to lower SHBG. That took it from 117 to 91 in three months. Not sure what else can be done?

Perhaps the lowered thyroid medication will begin to lower it? But that was not in the doctor’s initial reasoning for lowering it until I asked.

15

Maybe two minutes.

Custom/compounded T3/T4 is what you need. Get your thyroid straight and then deal with whatever test dose you need to get around the higher SHBG.

I do not think so.

Yes.

Yes.

Good luck, sounds like a mess. Hang in there.

16

This is a big no, you need to optimize thyroid independently of testosterone. Even if you stopped thyroid treatment altogether, your SHBG would still be out of control. Ideally it needs to be closer to 30 because FT starts becoming affected negatively in the 40’s.

17

Or just add more T to compensate. My shbg is still 91 but my free T is high 30’s. Of course it took 1500+ total T to get there though…

18

@systemlord and @highpull - I respect both of your opinions and appreciate the insight. Given everything, it’s unclear to me what needs to happen to address these things.

  • Free T3 is low. In August is was optimal at 3.9 but reverse t3 was on higher end. Now free t3 is 2.4 and rev t3 is low. Systemlord you suggest I’m in good hands with a defy doc (I believe she is an NP), while highpull you suggest I should return to NDT immediately

  • SHBG is high and it’s suggested this is going to be an issue with getting my free T and E2 levels in good range. I don’t know what needs to be done to getting SHBG to ideal range?

  • free T and E2 are low (both in single digits). I’ve started 200mg Test Cyp + 400ui HCG 2x per week. Apparently even with this, the SHBG bro nc só high, it may not be enough to get these levels optimal?

19

Sorry about any confusion. Systemlord loves Defy, there will be no criticism here. I question the legality of what they do, which is difficult for me to resolve in my head and get to some of the good stuff they likely do. Also, I believe a personal relationship, face-to-face, with your doctor is the way to go. Anyway, you are not doing well, you were doing well, the answer is obvious. By the way, reverse T3 is in a constant sate of flux and while part of the equation, is not the main driver in thyroid management as seems to be the case with your provider.

Yes, it will. What this means is you will need a higher dose of testosterone to get your free testosterone up to an effective level. SHBG also fluctuates and is usually difficult to change with diet, exercise and supplements, at least significantly. Don’t worry about the number, take enough test to get free test up.

Correct. You’re on the right path, see where you go. Some TRT doctors will titrate dosing upward until the desired effect is achieved.

Correct, the fact that your provider took this approach is difficult to understand. Perhaps there is more to the line of reasoning than we know?

It’s clear, more testosterone, T3/T4, get fT3 back to 4.0 (or higher if need be) and fT4 to at least mid-range.

Good luck moving forward. This is not always easy.

20

If all your thyroid levels decreased equally, this could be a sign T4 decreased suddenly which would affect the conversion rates of T4->fT4->fT3->rT3. You need more T4 medicine.

You will adjust your TRT dosage to manipulate SHBG, by throwing androgens at it to suppress it until FT levels are where you want them.